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Citation
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Condron M, Rowell SE, Dewey E, Anderson T, Lealiiee L, Farrell D, Hinson H. J. Trauma Acute Care Surg. 2018; 85(5): 888-893. |
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Abstract
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BACKGROUND: Traumatic injury is associated with an increased risk of coagulopathy and venous thrombosis. PAI-1 is a procoagulant molecule that inhibits tPA/uPA, thrombomodulin, and activated protein C. We hypothesized that elevated PAI-1 levels would be associated with increased Injury Severity Score (ISS) in injured patients with and without traumatic brain injury and that PAI-1 levels would vary with injury type.
METHODS: We retrospectively analyzed demographic, ISS, and hemodynamic data from a prospectively collected database. Patients with traumatic injury requiring Intensive Care Unit (ICU) admission (n=268) were classified as polytrauma, isolated body, or isolated head based on Abbreviated Injury Severity score. Admission PAI-1 levels were quantified using a Luminex analyte platform. Univariate tests for association informed the construction of a multivariate model of the relationship between PAI-1 and ISS.
RESULTS: PAI-1 positively associated with ISS (p <.0001) and was highest in patients with ISS>35 (p<.0001.) PAI-1 was significantly different between polytrauma, isolated body, and isolated head patients (p <.0001). On univariate analysis, age (p=0.0011), hypotension (p=0.0076), and alcohol intoxication (p=0.0024) were all positively associated with PAI-1 level. Admission international normalized ratio (INR) was not associated with PAI-1 level (p=0.638). After adjusting for age, sex, hypotension, and alcohol intoxication, higher PAI-1 levels were associated with higher ISS (p<.0001).
CONCLUSIONS: Elevated PAI-1 at admission is associated with higher injury severity score. This association is more pronounced in patients with hypotension. These findings suggest that PAI-1 levels may reflect the burden of endothelial damage and platelet activation after injury.Level of evidencelevel III, prognostic.
Language: en |